Risk by indication for pancreaticoduodenectomy in patients 80 years and older: a study from the American College of Surgeons National Surgical Quality Improvement Program

Abstract

Background: Expected mortality after elective pancreaticoduodenectomy (PD) in contemporary series is less than 5% in elderly patients; however, to our knowledge, mortality rate has not been correlated with indication for PD. We hypothesized that perioperative risk following PD would correlate with diagnostic indication in older patients. Methods:The American College of Surgeons NSQIP database was reviewed to identify patients (<80 and 80 years) who underwent PD from January 1, 2005, through December 31, 2012. High-and low-risk diagnoses were determined by using 30-day, major-morbidity data. Univariate and multivariable analyses were used to compare outcomes.Results: Pancreatic cancer and chronic pancreatitis were found to be low-risk diagnoses in elderly patients, whereas bile duct and ampullary neoplasm, duodenal neoplasm, and neuroendocrine tumors were high-risk diagnoses. The risk of 30-day mortality for older patients (80 y) undergoing PD was 6.1% for those with high-risk diagnoses vs 4.5% for those with low-risk diagnoses (P = .27). On multivariable analysis (controlling for confounders), a high-risk diagnosis was shown to be an independent predictor of prolonged length of stay, superficial surgical-site infection (SSI), and organ-space SSI. There was no increased risk of complications in patients 80 years with low-risk diagnoses. Conclusion:In patients 80 or older undergoing PD, perioperative risk varies by diagnostic indication.Patients should receive preoperative counseling about their risk.

Surgery for elderly patients with resectable pancreatic cancer, a comparison with non-surgical treatments: a retrospective study outcomes of resectable pancreatic cancer

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Study on the Validity of Pancreaticoduodenectomy in the Elderly

“…Previous studies in past fast two decades have compared the mortality and morbidity among younger and elderly patients who underwent PD (3,(8)(9)(10)(11). In the majority of these studies, postoperative mortality and morbidity of older patients were slightly higher, but comparable to those of younger patients; however, the differences were significant in several large series (3,(8)(9)(10)(11). In the present study, compared to patients younger than 75 years, patients aged 75 years and over had a significantly higher mortality rate, with half of the deaths being infection-related, such as pneumonia and sepsis due to catheter infection.…”

Malignant Duodenal Lesion - Duodenal Tumor Vs Pancreatic Tumor - Semiological Radioimaging Characteristics

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